Drug-Eluting Bead Transarterial Chemoembolization as Bridge Therapy for Hepatocellular Carcinoma Before Living-Donor Liver Transplantation

Update on Transarterial Chemoembolization with Drug-Eluting Microspheres for Hepatocellular Carcinoma

“…Although liver transplantation is a curative treatment for appropriately selected patients with HCC, a donor liver may not be immediately available, requiring the candidate to wait. By inducing ischemic tumor necrosis and inhibiting tumor progression, both c-TACE and DEM-TACE can extend the period, during which the patient meets the morphologic criteria for liver transplantation, as well as increasing the potential for curative treatment (2728). The reduction of active tumor tissue in such a setting would suggest that patients initially not fulfilling the morphologic criteria may ultimately be shown to benefit from liver transplantation (29).…”

“…4) (14647). Since the initial reports, multiple clinical trials have reinforced the use of DEM-TACE in patients with HCC (20284849). However, clinical results depended on many factors, including cancer stage, number of patients, type and size of microsphere, and follow-up duration.…”

“…Yu et al (28) conducted a prospective study of the effects of DEB-TACE in 60 patients with HCC who were evaluated before liver transplantation. Following initial DEB-TACE with DC Bead®, 40% achieved complete response and 33.3% achieved partial response according to the modified RECIST guidelines; among these, 15% had stable disease and 11.7% had progressive disease (Fig.…”

“…Of the 23 patients who initially did not meet the University of California San Francisco criteria for liver transplantation, 17 (73.9%) were successfully downstaged following DEB-TACE. The high percentage of patients who experienced tumor necrosis with minimal discomfort and without major complications suggests that DEB-TACE may be a safe and effective bridge therapy to liver transplantation in patients with HCC and poor liver function (28).…”

“Primum Non Nocere” in Interventional Oncology for Liver Cancer: How to Reduce the Risk for Complications?

“…Chemoembolization can be performed using the conventional technique (cTACE, a two-stage treatment with a drug mixed to lipiodol followed by embolic material) or using calibrated microspheres loaded with a drug (drug-eluted microspheres (DEM)-TACE). Indications and contraindications for DEM-TACE are similar to those for c-TACE, even if DEM-TACE is considered a better option than c-TACE for patients with more advanced disease or cardiac failure and for those expected to experience severe post-embolic toxicity [ 29 ].…”